Thursday, April 29, 2021

4/29/21 Medicare Update


Democrats Seek To Push Medicare Expansion As Part Of Biden’s $1.8 Trillion Families Plan, Defying White House

Democrats specifically aim to lower the eligibility age for Medicare to either 55 or 60, expand the range of health services the entitlement covers and grant the government new powers to negotiate prescription drug prices. Party lawmakers say their approach could offer new, improved or cheaper coverage to millions of older Americans nationwide.

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Roughly 100 House and Senate Democrats led by Rep. Pramila Jayapal (Wash.) and Sen. Bernie Sanders (I-Vt.) publicly had encouraged Biden in recent days to include the overhaul as part of his latest package, known as the “American Families Plan,” which proposes major investments in the country’s safety net programs. Yet Biden opted only to propose additional subsidies for Americans who purchase their health insurance, disappointing many lawmakers who still otherwise support the White House’s blueprint.

Sanders said Wednesday he would “absolutely” pursue a Medicare expansion as lawmakers begin to translate Biden’s economic vision into legislation. Sen. Ron Wyden (D-Ore.), the chairman of the tax-focused Finance Committee, similarly pledged that he would “look at every possible vehicle, and that’s starting today,” to lower drug costs.

And Sen. Richard J. Durbin (Ill.), the Democrats’ vote-counter in the chamber, said he planned to push for Medicare reforms he saw as a “game changer.” Durbin said he didn’t know why the White House ultimately chose to exclude the policies, but he predicted tough work ahead for Democratic leaders in crafting a legislative package that has sufficient support.

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“I don’t presume that we have a majority going in,” Durbin said. “I think we have to listen carefully to all the members and particularly those who have some problems, trying to resolve [them].”

The early efforts reflect a broader belief among congressional Democrats that they must more aggressively seize on their narrow but powerful majorities to push policies that long have been stalled in Washington — no matter their cost. Many party lawmakers have pushed Biden at times to spend sky-high sums, sometimes even more than the president himself says he supports, arguing that they have a political mandate to pursue vast economic change.

But health-care revisions are likely to present a significant challenge, threatening to open rifts not just between the two parties but within the Democratic caucus itself. In an early sign of trouble, Sen. Joe Manchin III (D-W.Va.) told The Washington Post on Wednesday that he opposes expanding Medicare eligibility even as he supports broader adjustments to the Affordable Care Act.

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“No, I’m not for it, period,” Manchin said when asked about efforts to expand the health-care entitlement.

Rethinking Medicare also risks touching off a fierce lobbying barrage on the part of health insurers and pharmaceutical giants, which have mobilized aggressively against such changes in the past. The corporate opposition could add to new political obstacles now facing one of the staple elements of Biden’s economic agenda.

In his address to Congress late Wednesday, Biden described his American Families Plan as a “once-in-a-generation” series of federal investments. And he specifically promised “in addition” to that package that he would try to lower health insurance premiums, reduce drug costs and pursue other reforms to the Affordable Care Act “this year.”

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“This is all about a simple premise: Health care should be a right, not a privilege in America,” the president said in his address.

The families package as proposed touches on wide swaths of the economy: It endorses universal prekindergarten for all children, two years of tuition-free community college for adults, and hundreds of billions of dollars toward combating child poverty and improving child care nationwide.

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The spending also has drawn staunch opposition from Republicans. Despite adding trillions to the federal deficit under President Donald Trump, GOP lawmakers blasted Biden on Wednesday for seeking to spend such sizable amounts — and for trying to couple the spending with proposed tax increases on wealthy families and profitable corporations. Sen. John Thune (S.D.), the Republican whip, sharply criticized the White House for putting forward “a big-government proposal financed largely on the backs of the American taxpayer.”

Rep. Virginia Foxx (N.C.), the top Republican on the House Education and Labor Committee, similarly faulted the Biden administration for pursuing community college and prekindergarten reforms she saw as pricey and ineffective.

“We can’t spend our way out of these problems,” she said.

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Manchin, a closely watched swing vote in virtually all significant policy fights in the Senate, also expressed some trepidation about tax increases outlined by Biden, including roughly a doubling of the capital gains tax rate for those earning more than $1 million per year.

“That’s a heavy lift,” Manchin said. “We just can’t make ourselves noncompetitive. We have an economy that’s ready to take off and boom. We can’t put the brakes on it.”

Most other Democrats, however, did not seem deterred — and some of the party’s leading lawmakers instead said the White House should seize on its rare opportunity to pursue even larger investments across the economy as part of the new families plan.

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“This is our chance to do big things on housing, and big things on infrastructure, and big things on poverty,” Sen. Sherrod Brown (D-Ohio), the chairman of a key committee that oversees housing, told reporters Wednesday.

For many Democrats, the most enticing target is Medicare, as they try to deliver on their 2020 campaign promises to make health insurance affordable and available. Biden himself endorsed a policy report after the party’s presidential primaries — part of a “unity” effort among Democratic contenders, including Sanders — that called for lowering the Medicare enrollment age and expanding the health services it covers.

But Biden opted against including any of those provisions as part of the American Families Plan on Wednesday, choosing instead to focus on extending the additional health insurance tax benefits that Congress previously adopted as part of the most recent coronavirus stimulus. The White House pointed as part of the plan to the president’s past support for a major expansion of Medicare that would lower the eligibility to age 60 and allow the government to negotiate drug costs.

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Asked about the approach, a White House official said the administration had embarked on an outreach campaign in the Capitol. The aide, who spoke on the condition of anonymity, said Vice President Harris has been phoning lawmakers to get their views on the American Families Plan.

Speaking at a press conference on Thursday, House Speaker Nancy Pelosi (D-Calif.) acknowledged “big interest in our caucus” particularly in Medicare reforms that aim to lower drug prices. But she declined to outline a path forward, saying: “What is in one bill or another is not really important.”

But other Democrats pledged to address both priorities in tandem. Sanders, who had lobbied Biden before the release of his plan, said this week that lawmakers are working “very hard” to ensure the inclusion of a Medicare expansion. His comment came just hours after he unveiled a government study that showed Americans pay between two and four times more for prescription drugs than citizens of other countries.

Citing the new data, Rep. Frank Pallone Jr. (D-N.J.), the chairman of the House Energy and Commerce Committee, also pledged to use his powerful gavel to turn to the issue in the coming weeks — stressing that tackling drug costs remains “one of my top priorities as we work to pass the American Families Plan.”

Jayapal, the leader of the Congressional Progressive Caucus, said Democrats across the Capitol are likely to intensify their political push in the coming weeks out of a belief that the president’s families plan is the most efficient route to improve Medicare — given the shrinking congressional calendar and the growing need for an overhaul.

“If we have to spend all the way through August working on the jobs and families plan[s], I don’t think we have the time,” Jayapal said about calls to tackle Medicare independently. “Everything gets harder heading into the midterms.”

Wednesday, April 28, 2021

4/28/2021 Auto Insurance Rates


Do Insurance Rates Go Up After A No-Fault Accident?

A previous accident can have an impact on your auto insurance premiums, depending on whether or not you're the responsible party. So, do your insurance rates go up after a no-fault accident? Let's find out.

What Is a No-Fault Accident?

When it comes to auto insurance, there are two kinds of accidents: at-fault and no-fault accidents. A no-fault accident means you weren't the party who caused the collision, while an at-fault accident means you're responsible for the crash. Auto insurance providers have specific fault assessment methods to determine which driver was at fault and which insurance company is responsible for compensation, says Coverage.

Also, each state has its own fault assessment rules. Some states are at-fault states, while others are no-fault states. It's important to know how your state determines fault in a car accident because it can affect the type of auto insurance you need to carry and the outcome of a claim in the event of an accident. Currently, there are 12 no-fault states, including Florida, Massachusetts, New York, New Jersey, Pennsylvania, Kentucky, Kansas, Michigan, Minnesota, North Dakota, Utah, and Hawaii. The other 38 states are at-fault states.

If you cause an accident, you can expect your auto insurance costs to go up. However, even if you aren't at fault, you may still face higher rates. According to The Balance, your premiums can increase depending on the circumstances of the accident, the types of coverage you have, and your claims history.

Will a No-Fault Accident Increase Your Car Insurance Costs?

Generally, a no-fault accident won't cause your car insurance rates to rise. This is because the at-fault party's insurance provider will be responsible for your medical expenses and vehicle repairs. If your insurer doesn't need to fork out money, your premiums won't go up.

In almost every state, a non-fault claim is filed against the auto insurance policy of the driver who is at fault. If you aren't responsible for an accident and you file a claim against the at-fault party, it's quite unlikely you'll see an increase in your car insurance costs. Even if you have to file against your own insurance policy, some insurance companies still won't charge you more because of a non-fault claim.

However, if you previously caused an accident or made a claim, your auto insurance rates may go up after a no-fault collision. According to the Consumer Federation of America, drivers who have been involved in no-fault accidents see an average premium increase of 10 percent.

If your premiums do go up following a no-fault crash, you should know that different insurers increase rates differently. Some may raise your premiums by 10 percent, while others may charge you only 2 percent more. In addition, certain states, such as California and Oklahoma, don't allow insurance companies to increase rates after a non-fault claim.

Will a No-Fault Accident Appear on Your Driving Record?

A no-fault accident will show up on your driving record. Suppose a negligent driver rear-ends your vehicle at a stoplight and causes your rear bumper to fall off. In such a situation, you'll have to contact your car insurance provider and file a claim to obtain compensation for the repair costs. Since you made a claim and received money from your insurer, it'll appear on your driving record, even though you weren't responsible for the accident.

Usually, an auto insurance claim will stay on your driving record for 3 to 5 years. Nonetheless, the duration may vary depending on the state where you live and the severity of the collision. Below are examples of how long different types of accidents can remain on your driving record:

  • No-fault accident: 3 years
  • Minor collision: 5 years
  • Hit-and-run accident: 8 years
  • DUI crash: 10 years
  • How Much Does a No-Fault Accident Raise Your Auto Insurance Rates?

    In a 2021 survey, The Zebra found that a no-fault accident increased annual auto insurance premiums by an average of $67 in 2020. The following are the average 6-month premiums from some of the leading auto insurance providers for drivers with a no-fault accident in their driving records:

  • USAA: $567
  • Nationwide: $639
  • GEICO: $642
  • State Farm: $677
  • Progressive: $770
  • Farmers: $869
  • Allstate: $1013
  • In What Situations Does Your Insurer Raise Your Premiums After a No-Fault Crash?

    If an uninsured driver hits your car, your car insurance company may be liable to pay compensation for the injuries and vehicle damage you sustain through your uninsured motorist coverage. Such coverage is designed to protect you against financial losses in an accident with an at-fault driver who doesn't have enough or any coverage. Although you aren't at fault, the accident makes it costlier for your auto insurance provider to do business with you, so they'll likely pass the extra cost to you by raising your premiums. However, you can always look for another insurer if you're unhappy.

    In the above situation, suppose the at-fault driver fled the scene rather than stopping to exchange information with you. Your auto insurance company may also increase your premiums if you decide to file a non-fault claim. At least, a non-fault claim usually comes with a lower surcharge compared to an at-fault claim.

    You may be surprised at the number of factors that can influence your auto insurance costs. Filing an at-fault claim will almost surely raise your premiums, but you may be able to avoid that by taking advantage of your insurer's accident forgiveness program if they have one. However, a no-fault claim can also be used to increase your rates in some situations, such as a no-fault accident with an insured or hit-and-run motorist.

    If your auto insurance provider raises your premiums after you file a no-fault claim, you may want to consider switching to another carrier. The new rates will apply on your policy renewal date, so you may have enough time to shop around. Make sure you ask any prospective insurer if they surcharge for a no-fault accident. It may be better to choose a company that quotes a higher rate but doesn't surcharge than a more affordable one that raises your premiums after a no-fault accident.

    4/28/2021 Car Accident Insurance


    When Does Car Insurance Go Down After An Accident? Everything You Need To Know

    If you get in an auto accident, your auto insurance premiums will likely increase even if the accident was not your fault. When does car insurance go down after an accident? Review this guide to find out when you can expect relief.

    Average Insurance Increase After an Accident

    Insurance customers who file an accident claim see an average annual premium increase of $767, nearly 50 percent higher than the average rate of $1548 for drivers who have clean records. Usually, the increase remains for at least three and up to five years, which results in a total increase of $2300 according to calculations by Policy Genius.

    Some companies do not raise customer rates for accidents they did not cause. For example, Quote Wizard reports that USAA, an insurer for military members and their families, promises to keep premium costs the same for policyholders who file claims but did not have responsibility for the collision.

    Some states have specific laws about raising customer insurance premiums. For example, in New York, insurers can only increase policy rates after at-fault accidents that involve more than $2000 in property damage or any bodily injury.

    Average Insurance Increase by Company

    The Zebra reports that State Farm, GEICO, and USAA offer the smallest price increases after an auto accident. In fact, USAA and GEICO have accident forgiveness programs that allow you to keep your rates the same even if you file a claim. However, you cannot access this type of coverage in every state. In addition, you usually have to have at least three years without a claim before qualifying for accident forgiveness.

    The website ranks the average annual increase by company after an auto accident as follows:

  • State Farm - $304
  • USAA - $340
  • Farmers Insurance - $701
  • Liberty Mutual - $710
  • GEICO - $721
  • Nationwide - $826
  • Allstate - $1129
  • Progressive - $1168
  • Timing of Insurance Increase

    As mentioned above, most insurance companies will remove the accident surcharge within five years of the collision if you have no further accidents during that time. The Zebra notes that the farther the incident occurs to your policy renewal date, the longer you can expect to pay more money for auto coverage.

    While three years is the average duration of an auto insurance increase after an accident, you may have to pay a higher premium for more than 36 months after a bodily injury claim, accident involving driving under the influence, reckless driving ticket or accident, accident causing serious bodily injury or death to another person, or several violations within a short time period.

    In any of these cases, the state may require you to get high-risk, or SR-22, insurance. You might be unable to get coverage from a traditional auto insurer at an affordable rate. You might also have to serve a license suspension before you can qualify to get car insurance again. You have to prove that you have liability insurance to obtain driving privileges with an SR-22.

    Reasons for Insurance Increase

    Insurance companies raise rates after accident claims for a few reasons, including the increased risk associated with insuring customers who have already had one accident. Statistically, these individuals have a higher likelihood of another accident, which makes them more costly for insurers. Insurance firms also want compensation for the cost of the time, parts, and labor associated with your claim. These surcharges typically do not fall under your standard premium costs.

    Premiums don't always go up after an auto accident. For example, rates may not increase after a collision another driver caused, after a small fender bender, if you have not had an accident in at least six years, or if you have accident forgiveness on your policy. However, even in these instances, you might lose a good driver discount.

    Driving Record Considerations

    Nerd Wallet reports that you can expect an accident to stay on your driving record for several years. The exact amount of time varies by state, so check with your local Department of Motor Vehicles to learn more. For example, California retains information about violations and accidents for about three years, but details about more serious convictions such as driving under the influence for about 10 years. Accidents appear on your record even if you were not at fault if the incident resulted in injury, fatality, or more than $1000 in property damage.

    In Florida, a motor vehicle collision appears on your driving record only if you get a ticket after the accident. In this case, it will remain on your DMV report for up to five years, or longer for more serious offenses. In fact, a DUI stays on your record for 75 years in Florida.

    Saving Money on Insurance After an Auto Accident

    You can often save money on your auto insurance premiums after an accident by looking for a better rate with a different insurance company. Since every insurer has its own algorithm to calculate quotes, be sure to fully research available policies.

    When you shop around for quotes, ask each company about available discounts, including those they may not readily advertise. Common discounts include price breaks for safety or anti-theft features in your vehicle, reducing your average mileage, or earning at least a B average if you're a high school or college student.

    Sharing a policy with a driver who has a clean record and several years of experience can often lower your rates. You can also bundle your homeowner's or renter's policy with your auto insurance policy to save.

    Avoid filing a claim if at all possible, especially soon after another accident claim. You'll likely see an even bigger rate increase in this case, even for a minor collision. Paying out-of-pocket can potentially save you a lot of money on insurance premiums in the long run.

    If you have an older car, you can usually drop comprehensive and collision coverage to save money after an accident. Other unnecessary add-ons include rental car reimbursement and roadside assistance policies.

    Check this out if you need additional information, resources, or guidance on car insurance.








    Tuesday, April 27, 2021

    India and Corona Virus 4/27/2021


    Coronavirus Has Crushed India’s Health System. Patients Are On Their Own.

    a person wearing a costume: The fiancee of a person who died of the coronavirus breaks down during a cremation in Guwahati, India, on Tuesday. © Anupam Nath/AP The fiancee of a person who died of the coronavirus breaks down during a cremation in Guwahati, India, on Tuesday.

    NEW DELHI — When Rehmat Ahsan began to have trouble breathing last week, his family went from hospital to hospital in India’s capital looking for a bed in a covid-19 ward. Everywhere they tried was full.

    Then they started a new search — for the oxygen that might save his life.

    Ahsan’s older brother said he found an oxygen cylinder from a private vendor for $350, five times the normal price. It lasted eight hours. When he tried to refill the cylinder, he found hundreds of people waiting in line.

    By the time he found more oxygen several hours later, Ahsan was struggling for every breath. Later that afternoon, he died at home.

    “He was a strong man, a fighter who was defeated by an incompetent system,” said Mohammed Rizwan Alam, his elder brother. He believes his brother, a 49-year-old shopkeeper and father of two daughters, would still be alive had he received proper care.

    a man standing in front of a group of people posing for the camera: Rehmat Ahsan, seen with his wife and two daughters, died of the coronavirus in New Delhi. © Family photo/Family photo Rehmat Ahsan, seen with his wife and two daughters, died of the coronavirus in New Delhi.

    In India’s devastating second wave of coronavirus infections, patients and their families are on their own, fighting to save their loved ones in an overwhelmed system where ambulances, hospital beds, oxygen, medicine and even cremation grounds are in short supply.

    India’s health-care infrastructure is buckling as a record-breaking surge of infections exposes what experts say are decades of underinvestment combined with a lack of preparation by the government for a second wave. The country is reporting more than 300,000 cases and nearly 3,000 deaths a day, although official figures understate the scale of the calamity.

    Some are dying not because they have covid but because they cannot access proper care. Late Tuesday in Delhi, there were just nine intensive care beds for covid patients available in a city of more than 17 million, a government dashboard showed, with 11 such beds reserved for pregnant women and children. Each day brings reports of people dying just outside hospitals.

    Countries around the world, including the United States, have pledged to assist India with medicines, supplies of oxygen and raw materials for vaccines as it battles the new wave of infections. But the need in India is immediate, and it’s unclear how quickly help from abroad will arrive.

    a group of people standing in front of a crowd: Family members and ambulance workers carry the bodies of patients who died of the coronavirus at a cremation ground in New Delhi on Tuesday. © Prakash Singh/AFP/Getty Images Family members and ambulance workers carry the bodies of patients who died of the coronavirus at a cremation ground in New Delhi on Tuesday.

    Indian Prime Minister Narendra Modi said a “storm has shaken the country” and urged all Indians to get vaccinated. The government is working to boost the supply of oxygen and increase the number of hospital beds and intensive care units.

    For many Indians, the additional capacity will come too late. Vinay Srivastava was a 65-year-old retired journalist in the city of Lucknow. His family, like thousands of others in India, faced a gauntlet of obstacles when he contracted covid. Over two days, he documented the deterioration of his condition on Twitter.

    After Srivastava’s oxygen levels plunged on April 16, his son Harshit managed to find an empty cylinder and fill it. His father’s condition improved briefly, but by the next morning, his blood oxygen level had fallen to 70 percent, a level considered life-threatening.

    Inside a Delhi hospital, oxygen runs fatally short as cases mount

    When Harshit tried to get his father admitted to a covid ward, he was turned away from the same hospital twice. He was told that he would need both a positive result on a specific type of coronavirus test called an RT-PCR and a referral letter from a senior medical official. The former would take two days. The latter proved impossible to obtain, even after Harshit tried to visit the official in person.

    His father’s tweets told of the family’s desperation: “No hospitals, labs or doctors are picking up the phone,” he wrote on April 16. When a government official asked for more details the next day, Srivastava replied with a photo of his pulse oximeter reading. “My oxygen is 31 when [someone] will help me,” reads the last tweet from his account. Harshit said his father collapsed soon after.

    “Medical treatment could have saved him,” said Harshit, who blames the state government for his father’s death. “Nobody came to help.”

    Days after news of Srivastava’s death spread, the state government ended the requirement that coronavirus patients obtain referral letters from a senior medical official before being admitted to private hospitals. “It came to our notice that people were facing difficulty so that system was withdrawn,” said Navneet Sehgal, a senior official in the state government.

    In another part of the same city, Blessing Lyall, 32, first had to struggle to get her mother Claris tested for the coronavirus and then to get an oxygen cylinder as she became weaker and weaker. A doctor told Lyall to take her mother to the hospital, but every hospital she and her friends called was full — and her mother did not want to be separated from her only child. Lyall’s father died in December.

    Lyall found an oxygen cylinder for her mother, but it ran out on April 17. She sent scores of messages, reaching out to everyone she knew, frantically calling every number anyone suggested to find a refill. Nothing worked.

    It became difficult for her mother to speak.

    “Mom was so scared,” Lyall said. “She knew she did not have much time.”

    On the morning of April 20, Lyall woke to find that her mother had died. Two hours later, she learned that an oxygen cylinder had become available. For the following week, Lyall was entirely alone with her grief — she, too, had tested positive for the coronavirus and could not leave the house.

    a group of people standing in front of a sign: A man carries an oxygen cylinder for a patient at a coronavirus hospital in New Delhi on Tuesday. © Idrees Mohammed/EPA-EFE/Shutterstock A man carries an oxygen cylinder for a patient at a coronavirus hospital in New Delhi on Tuesday.

    Sadaf Jafar, a political activist in Lucknow, was one of the people who tried to help Lyall find an oxygen cylinder. None of the official helplines are working, Jafar said, and the most-senior medical official in the area had switched off his phone. “The state is not available anywhere,” she said.

    Countless volunteer efforts have emerged to try to fill the vacuum, but they only serve to highlight the direness of the situation. Gurpreet Singh Rummy, the founder of a Sikh social service organization, said Tuesday that he hadn’t slept for four days, ever since he and his team launched an effort to provide free oxygen to those who need it. The patients arrive all through the day and night in cars and three-wheeled auto rickshaws at a Sikh temple, or gurdwara, near Delhi.

    “These are very serious patients who don’t have time to even reach hospitals,” said Rummy. His group is prioritizing those with oxygen levels under 50 who may be “on their last breath.”

    Even when coronavirus patients die, the scarcity of resources continues. Vasundhara Bijalwan’s father, Pradeep, a 67-year-old doctor who dedicated his life to serving Delhi’s homeless, died at home of covid-19 last week. She and her mother — both coronavirus-positive themselves — had earlier spent hours calling hospitals trying to get a bed for her father. The numbers were either not working or busy.

    Finally, they found a spot in a small hospital. The next morning, however, they discovered that the facility’s oxygen supply was on the verge of running out. They brought Pradeep home and gave him oxygen there using a machine that concentrates it from the air. When he continued to deteriorate, he told them he was fine at home, where he would be surrounded by family, no matter what happened.

    After his death, the family called crematoriums, but there were no slots available. Ultimately they paid an agent to handle the process at the suggestion of a neighbor whose relative died of covid-19 at almost the same time.

    Because she was in isolation, Bijalwan was unable to attend her father’s cremation. Her cousin told her there were so many bodies at the crematorium that four families were eyeing a single spot, hovering and angling for position.

    “It’s not just about my father,” said Bijalwan. “Nobody should go like this.”

    Saurabh Sharma in Lucknow contributed to this report.

    Indian Health Minister Says Country Better Prepared To Beat COVID Than In 2020 As Cases Top 17 Million

    a group of people that are standing in the snow: Family members and ambulance workers in PPE kits (Personal Protection Equipment) carry the bodies of victims who died of the Covid-19 coronavirus at a crematorium in New Delhi on April 27, 2021. © Prakash Singh/Getty Family members and ambulance workers in PPE kits (Personal Protection Equipment) carry the bodies of victims who died of the Covid-19 coronavirus at a crematorium in New Delhi on April 27, 2021.

    India's health minister said on Tuesday that the country is better prepared to beat COVID-19 than in 2020, despite the country experiencing a massive surge in cases that's straining medical resources.

    The official, Harsh Vardhan, tweeted a video with text that read, "Today we are in a much stronger position against Corona than in 2020. In 2020, we started our fight from zero, because no one knew anything about this virus at that time."

    According to a health ministry statement, Vardhan also said that India is "better prepared mentally and physically with more experience to beat the pandemic as compared to 2020."

    The statement noted that Vardhan's comments were made during a virtual webinar where he announced "a series of blood donation camps at 13 different locations in Chandigarh, Punjab, Haryana and Himachal Pradesh."

    The camps are being organized by the Competent Foundation as well as non-governmental organizations (NGOs) to help fulfill the "blood requisition due to COVID pandemic."

    Vardhan's comments come as India surpasses 17 million confirmed cases. According to a tracker from Johns Hopkins University, the nation is also nearing 200,000 COVID-related deaths. On Monday, India reported that more than 117 people were dying from the disease every hour.

    4/27/2021 Breast Cancer Update


    Sentinel Node Biopsy Alone For Breast Cancer Patients With Residual Nodal Disease After Neoadjuvant Chemotherapy

    Traditionally ALND has been the standard surgical choice for patients with primary breast cancer or node-positive disease after NAC. Because ALND is associated with a significant risk of well-known complications such as lymphedema and peripheral neurologic sequelae, there has been a trend toward less extensive axillary surgery . SLNB has replaced axillary evaluations for patients with primary breast cancer who have clinically negative nodes5. Several recent trials have provided evidence for further limiting the indication of ALND. The results of the ACOSOG Z0011 and the IBCSG 23–01 trials show that ALND is not needed in women with early stage breast cancer with limited axillary nodal burden2,6.

    However, more evidence is needed to validate a reduction in the extent of axillary surgery for SLNB in patients who are clinically node-positive and have been treated with neoadjuvant chemotherapy. An important issue regarding the use of SLNB only instead of ALND is the reliability of the procedure and its results. Initial concerns about the feasibility of sentinel lymph node biopsy following neoadjuvant chemotherapy have been based on potentially altered lymphatic drainage after chemotherapy and possible nonuniform response of tumor burden from the treatment7. The false-negative rate has been a major issue, especially for patients with clinically node-positive disease. The ACOSOG Z1071 clinical trial showed that the false-negative rate of SLNB after NAC in patients with cN1 and at least 2 sentinel nodes identified during surgery was 12.6%8. Among the 343 patients who had undergone both SLNB and ALND, the overall false-negative rate was 10.7%, with no significant difference according to pretreatment node status (p = 0.51)9. Another study on the reliability of SLNB following neoadjuvant chemotherapy revealed a false-negative rate of 13% and a sentinel lymph node identification rate of 91%10. However, according to the SENTINA study, the false-negative rate was 7% or less when three or more sentinel nodes were removed, compared to 19% with two nodes removed and 24% when only one node removed11. In the present study, the mean number of the harvested sentinel lymph nodes was 4.20 for the SLNB only group and 4.26 for the ALND group. Also, because the majority of both groups had three or more axillary nodes removed (92.5% vs 90.0%), SLNB could be considered reliable based on the prior research results.

    Several trials have been trying to prove the feasibility of omitting ALND for patients with limited axillary tumor burden, especially for ypN0 cases following neoadjuvant chemotherapy. There has been increasing acceptance of omitting ALND following neoadjuvant chemotherapy in patients with cN1 disease who have been found to have a negative SLNB. According to Caudle et al., 55.9% of surgeons who are familiar with the ACOSOGZ1071, SENTINA, and SN-FNAC trials are currently offering SLNB to > 50% of their patients with planned omission of ALND if SLNB is negative even though they are initially node-positive3.Kang et al. Reviewed 1,247 patients who had breast cancer with clinical conversion of axillary nodes from positive to negative after neoadjuvant chemotherapy. Of these patients, 819 patients in the ALND group and 428 patients in the SLNB group had similar axillary and distant recurrence-free survival12.

    Patients treated with neoadjuvant chemotherapy who are at least ypN1 at SLNB are considered to have residual nodal disease, and ALND still remains the standard of care. To the best of our knowledge, few studies have addressed the safety of SLNB only for patients with ypN1 breast cancer, especially with 1 or 2 positive lymph nodes. In the present study, the omission of ALND was not associated with an inferior outcome in both non-matched and matched analyses in terms of ARFS, DMFS, OS, and BCSS. The results showed a lack of significant differences in outcomes between the SLNB only group and the ALND group in residual nodal disease after neoadjuvant chemotherapy. A recent retrospective study of 1,617 ypN1 patients (ALND, 1,313; SLND, 304) after neoadjuvant chemotherapy reached a rather conservative conclusion13. According to their data, the SLNB group showed significantly low survival in both univariate and multivariate analyses (HR = 1.7; 95% CI = 1.3–2.2, p < 0.001), with an estimated 5-year OS of 71%, compared with 77% in the ALND group (p = 0.01). However, there are differences in subsets of patients. Over 20% of patients had three positive lymph nodes, and this group of patients were excluded in our study. Furthermore, nearly 30% of patients were in stage 3 compared with our study population of 15% after the propensity score matching. In addition, the results of their specific subset of patients were similar to those of our study. They performed a matched subgroup analysis for patients with luminal A or B tumors and residual disease in a single lymph node. The results from the SLNB only and ALND groups were equivalent in this subset of patients (HR = 1.03, 95% CI = 0.59–1.8, p = 0.91). Also, a Kaplan–Meier analysis showed similar survival rates between the two groups, with an estimated 5-year OS of 85% and 82% for SLNB only and ALND, respectively (p = 0.88). In our study, the survivals were no different either before or after matching patients. We think that we recruited eligible patients who had only 1 or 2 metastatic nodes for analysis before matching. Among a number of variables we matched for patients’ details, the number of affected nodes may be one of the most influential factor for the survivals. Also, adjuvant therapy might be effective enough to override the baseline differences for patients with residual 1–2 nodal disease after NAC.

    The multivariate analysis after matching of this study, performed to clarify the factors that exhibit significant influence on the oncologic outcome, revealed that radiation therapy was involved with improved ARFS, DMFS, and BCSS. Among other factors, the pathologic node metastasis was significant only for ARFS. We recruited patients’ data with low burden axillary disease, with only 1–2 lymph node metastasis. Thus, pathologic node, the well-known prognostic factor might not be revealed to be significant for DMFS, OS and BCSS. Our data also suggested that radiation therapy is significantly related with survival, while the univariate, multivariate, and propensity score-matched data exhibited no statistical differences between the SLNB only and ALND groups. As shown in Table 5, radiotherapy treatment was correlated with a low risk of ARFS (HR = 0.10, p = 0.018), DMFS (HR = 0.26, p = 0.046), and BCSS (HR = 0.05, p = 0.032) after matching. According to Donker et al., axillary radiotherapy can be considered as an effective alternative to ALND with acceptable outcome14. While the role of post-mastectomy radiation therapy in cN1 patients is still an area of investigation, one retrospective analysis of 15,315 cases (mastectomy, 10,283; breast-conserving surgery, 5,032; both ypN0 or ypN +) from the national cancer database has addressed this issue. In a subset analysis, OS was improved with post-mastectomy radiation therapy in the ypN1 subgroup (p < 0.0515. Among ongoing trials, a randomized phase III trial has been comparing ALND to axillary radiation in patients with breast cancer (cT1-3 N1) who have positive SLN after receiving neoadjuvant chemotherapy (AlllianceA011202). One arm comprises of ALND with nodal radiation (ALN level III and supraclavicular fossa) but no radiation to dissected axilla (ALN levels I–II), while the other arm is axillary radiation plus nodal irradiation (ALN levels I–III and supraclavicular fossa). These results should help clarify the role of axillary irradiation and thus the appropriate surgical choice for patients with ypN1 breast cancer.

    Our study has several limitations. First, this study was retrospective in nature and was conducted at a single institution. And we admit that it is possible for the data to involve potential selection bias for eligible SLNB only group who might be good responders to preoperative chemotherapy. Because the patients’ clinical response to chemotherapy may clearly influence a surgeon’s decision whether to directly proceed to ALND or not. Hence, in order to control other confounding variables, we conducted a propensity score matching to reduce the selection bias. Also, these data were collected from 8 breast surgeons of AMC and we share same protocol about surgical approach based on the NCCN guideline, but not all surgeons had the exact same threshold to make decisions whether to perform ALND or not. Furthermore, we generally include clinically enlarged but without gamma signal, non-sentinel lymph nodes to the SLNB procedure so that the number of excised nodes for SLNB group may be relatively high. On the other hand, the fact that the data was collected from surgeons of diverse opinion on the axillary surgery may be a partial reflection on the actual clinical practice. Because, in the real clinical practice, each surgeon has his or her own perspective and threshold for axillary surgery. Finally, in the absence of randomized controlled trials about this issue, we believe our study might be an addition of supporting evidence for reducing axillary surgery extent while minimizing ALND-associated morbidity and preserving patients’ quality of life.

    In conclusion, omission of ALND for 1 or 2 positive sentinel lymph nodes after neoadjuvant chemotherapy may not compromise locoregional control or survival. The results of this study demonstrated that the ALND-associated morbidity might be avoided without decreasing cancer control in patients with limited nodal burden after neoadjuvant chemotherapy. However, final treatment decisions should always be made in the context of a multidisciplinary setting to maximize regional control and minimize treatment related morbidity (Supplementary Information).

    Thursday, April 22, 2021



    Health Insurance For $10 Or Less A Month? You May Qualify For New Discounts

    The Biden administration has opened up enrollment on all Affordable Care Act marketplaces, including on the federal insurance exchange, <a href=Healthcare.Gov, until August. Many people will qualify for better or less expensive plans — or both." "The Biden administration has opened up enrollment on all Affordable Care Act marketplaces, including on the federal insurance exchange, Healthcare.Gov, until August. 

    Signing up for health insurance can be a confusing headache. At the same time, the need for a financial safety net if someone in your family gets sick is incredibly important. With the ongoing pandemic and economic crunch, the stakes are even higher.

    Now, during a special enrollment period, the Biden administration is trying to make getting health insurance irresistible — and simpler, too.

    You can sign up on all Affordable Care Act marketplaces, including the federal insurance exchange, Healthcare.Gov, until August. And in the nearly $2 trillion pandemic relief bill passed earlier this year, the government included $35 billion to make premiums and other health insurance costs more affordable.

    In fact, for several groups of people, it's possible to enroll in health coverage for zero dollars in monthly premiums. Many more — the federal government estimates four out of every five enrollees — qualify for plans with premiums of $10 or less per month.

    If you need health coverage or want to see if you can lower your costs, here are six tips for taking advantage of these new prices and options.

    1 - Know your deadlines and be prepared

    In most states, you have until Aug. 15 to choose a plan on Healthcare.Gov, and nearly all adults are eligible to sign up.

    If you live in the District of Columbia or one of the 14 states that has its own insurance website, check this list to find out where to enroll. Be sure to double-check enrollment rules and deadlines, since they may be different than the ones for Healthcare.Gov.

    And to make things easier on yourself, pull together all the documents you'll need, such as Social Security cards, immigration documentation and tax returns, before you start your search.

    2 - Who can get those zero dollar plans?

    First of all, zero dollar premium ACA plans aren't new. The Kaiser Family Foundation estimates that there are already about 4.5 million uninsured people who qualify for zero premium "bronze" plans, the most basic tier of insurance options.

    What's different now is that people also can get better, more comprehensive "silver" plans with no monthly premiums.

    "Anyone earning less than 150% of the poverty line — which is around $19,000 a year if you're single, or around $39,000 a year for a family of four — anyone below that cutoff point pays nothing for the benchmark silver plan," explains Charles Gaba, who analyzes health care data and policy at ACASignups.Net. Silver plans cover about 70% of your health care costs — compared to 60% for bronze plans.

    Another group that can get zero dollar plans is people who lost a job in the last year and couldn't afford COBRA premiums — the program for continuing an employer-based insurance plan after a layoff.

    "Thanks to these subsidies, they can now get 100% of their COBRA premium paid for at least through September," says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. She says your employers should contact you with details about how to receive this benefit if you qualify. This Department of Labor FAQ provides more details.

    There's one more group that can get zero dollar plans. "If you've gotten any unemployment benefits this year, you get a very rich plan — what's called a platinum level plan, that essentially covers all but a very small amount of a patient cost sharing," says Corlette. That provision of the law hasn't gone into effect yet — the government expects those savings will be available starting in early July.

    3 - Not free, but cheap

    While you may be eligible for zero dollar plans, they aren't always the best option, says Jeremy Smith, a health insurance navigator at the nonprofit First Choice Services in West Virginia. Navigators give free advice to people who want to enroll in ACA plans.

    "The catch with a lot of the zero dollar plans is they still have pretty high deductibles in a lot of cases," Smith explains. (The deductible is the amount you have to pay out-of-pocket for covered services before your insurance starts picking up the tab.)

    Younger people who don't use their insurance very often might go for the zero dollar plans, but Smith is seeing a lot of people opt for plans that cost something every month, but have lower overall costs.

    "It's still saving them some money and it's a better deductible and out-of-pocket maximum, so they've really been able to use this opportunity to get what's even better coverage for them and their family," Smith says.

    A few weeks ago, Maria Graciela Lopez in Tampa Bay, Fla., decided to keep her bronze plan, but with the new discount. She had been paying $364 a month to cover herself and her husband. Starting May 1, Lopez says they will pay $209.

    "That's like $160 less than we used to pay every month — that is a big deal," she says. Lopez even convinced her son to leave his employer-based insurance and sign up for an ACA plan that covers his allergy shots.

    Bottom line: Don't let past experience — or what you may have heard about affordability — stop you from checking out what's available right now, says Gaba of ACASignups.Net.

    "Even if you checked last year — you went to the site, you checked, 'Oh, I don't qualify' or 'Oh, it's still too expensive' — check again, because the subsidies have been beefed up dramatically," he says.

    3 - New flexibility, with a catch

    If you're already enrolled in a marketplace plan that you're happy with, all you have to do to get these new rates is to log in, click to apply for coverage, and re-select your current plan. You'll get the new rates on your premiums and other costs for the rest of the year, starting the month after you complete your application.

    You don't have to pick the same plan — if you find one that gives you better coverage or lower rates, you can select that instead. But be warned: Because this special enrollment period is in the middle of the year, your deductible might reset if you switch plans. If you've already paid a lot toward your deductible this year, it might be costly to start over.

    Theoretically, you could even change plans more than once before Aug. 15, if your new plan turns out not to be a good fit. But again, make sure to consider that you might have to start from scratch on your deductible.

    4 - The usual reminders

    If you're not ready to commit just yet, you can browse your options using "window shopping" tools on Healthcare.Gov or your state marketplace. You can see full priced plans, or enter information about income and dependents to get an idea of how much of a subsidy you could get to lower those costs.

    Also, remember not to focus just on your monthly premium; it's important to look at other costs, too. When you're browsing plans, HealthCare.Gov and some state marketplaces will show your "estimated total yearly costs" for each plan. This takes into account the plan's deductible and copays, plus how much health care you expect to use.

    Though it's hard to predict if you're going to get injured or pregnant or sick in the coming year, leverage what you do know about your health needs. If you have a doctor you like, or if you know you need a certain prescription drug, look for a plan that covers them. HealthCare.Gov allows you to search for and select specific doctors and drugs to easily see if they're covered.

    5 - Beware of too-good-to-be-true plans

    If you see a good deal online, make sure you're looking at an ACA plan. When you search for health insurance on the internet, you may stumble on short-term plans that advertise much lower monthly premiums, but don't cover the ACA's famous 10 essential benefits, including hospitalization and maternity coverage.

    You can also quality-check ACA plans. Healthcare.Gov introduced a star rating feature a few years ago, similar to what consumers use on Yelp or Amazon. The ratings are based on information insurers submit regarding cost, combined with enrollee feedback, and can help you identify plans people are happy with.

    6 - Get free help from the pros

    If you're still overwhelmed, help is available — and free of charge. Navigators across the country are trained and ready to help people enroll in ACA plans. The Trump administration slashed federal funding for navigators, but they're still out there, and the Biden administration is beginning to reinvest in the program.

    In the COVID-19 era, many navigators meet with you virtually, by phone or video chat. Smith, the navigator in West Virginia, says it takes people about an hour and a half to sign up.

    Katie Roders Turner is a navigator with the Family Health Care Foundation in the Tampa Bay, Fla., area. She's busy calling previous clients, letting them know that there are new subsidies and that it's worthwhile to see if they can get a better deal.

    Since there's a longer window of time during this special enrollment period — a total of six months versus six weeks during the standard, annual open enrollment in the fall — Roders Turner says the process is "no longer a sprint," but "a marathon."

    But she points out that the quicker you reenroll or sign up, the quicker you can take advantage of these rates. "If you want your coverage to start May 1, let's get that appointment in now and do our selection so that your coverage can begin sooner — in addition to the savings, of course."

    NBA Finals: Are the Suns equipped to handle their latest playoff adversity vs. Bucks?

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